1. Shoulder Girdle Muscular Anatomy

2. Shoulder Girdle Retraction (Adduction)

3. Rhomboid Major Origin Insertion Action Nerve Supply Palpation
Spinous processes of T2 to T5
Insertion
Medial border of scapula
Action
Scapulae retraction, medial scapula rotation
Nerve Supply
Dorsal Scapular Nerve
Palpation
Side lying, with arm hanging over edge of bed to abduct scapulae. Palpate obliquely downwards and lateral from spinous process to medial scapula border

4. Rhomboid Minor Origin Insertion Action Nerve Supply Palpation
Spinous process of C7 to T1
Insertion
Upper medial border of scapula
Action
Scapulae retraction, medial scapula rotation
Nerve Supply
Dorsal Scapula Nerve
Palpation
Side lying, with arm hanging over edge of bed to abduct scapulae. Palpate obliquely downwards and lateral from spinous process to medial scapula border

5. Trapezius Origin Insertion Action Nerve Supply Palpation
Medial superior nuchal line, external occipital protuberance, ligamentum nuchae and the spinous process of C7-T12
Insertion
Posterior aspect of the lateral clavicle, medial acromion and the upper border of the spine of the scapula
Action
Upper fibres- elevation, neck extension, ipsilateral lateral flexion, lateral rotation of the scapula
Middle fibres- shoulder retraction
Nerve Supply
Accessory nerve (11th Cranial Nerve)
Palpation
Model in prone. Place palpating hand over the upper trapezius. Have model actively abduct the arm at the shoulder joint and retract the scapula. Repeat above to palpate the middle and lower trapezius. To further bring out the upper trapezius, have model slightly extend the neck
Trapezius

6. Shoulder Girdle Protraction (Abduction)

7. Serratus Anterior Origin Insertion Action Nerve Supply Palpation
Outer surface of the upper 8-9 ribs and the intercostal fascia
Insertion
Costal surface of the medial border of the scapula
Action
Scapular protraction, scapular upward rotation, stabilises scapular to prevent medial border winging
Nerve Supply
Long thoracic nerve
Palpation
Side lying with arm resting on therapist shoulder. Therapist standing caudad facing cephalad. Palpate from axilla along chest wall

8. Pectoralis Minor Origin Insertion Action Nerve Supply Palpation
Outer surface of the 3rd,4th and 5th ribs and the intercostal fascia
Insertion
Upper surface ad medial border of the coracoid process of the scapula
Action
Anterior tilt of scapula
Nerve Supply
Medial pectoral and Lateral pectoral nerves
Palpation
1)Side lying with arm resting on therapist shoulder. Therapist pulls models arm forward to allow therapists hand to be placed posterior to pec major and directly onto caudal end of pec minor on the 5th rib. 2)In high sitting ask client to place hand behind back. Then ask them to further extend the shoulder whilst the therapist palpates 3rd, 4th and 5th ribs below the coracoids process.
Pectoralis Minor

9. Shoulder Girdle Elevation

10. Transverse process of C1-4
Levator Scapulae
Origin
Transverse process of C1-4
Insertion
Medial margin of the scapula between superior angle and spine of scapula
Action
Elevation, shoulder retraction, neck extension, ipsilateral lateral flexion, medial scapular rotation
Nerve Supply
Ventral rami of C3-4
Palpation
Supine, ipsilateral cervical rotation, hand behind back. Palpate anterior to upper trapezius fibres and follow down onto superior angle of scapulae

11. Glenohumeral Abduction

12. Supraspinatus Origin Insertion Action Nerve Supply Palpation
Medial two thirds of the supraspinous fossa
Insertion
Upper facet of the greater tubercle of the humerus
Action
First 20° of abduction, stabilise humeral head into glenoid
Nerve Supply
Suprascapular nerve
Palpation
Tendon- place model into glenohumeral maximal extension, medial rotation and adduction. Tendon can be palpated anterior to the acromion

13. Deltoid Origin Insertion Action Nerve Supply Palpation
Anterior- anterior border of lateral third of clavicle. Middle- lateral margin of the acromion process. Posterior- lower lip of the crest of the spine of the scapula
Insertion
Deltoid tuberosity
Action
Abduction, flexion, extension, medial rotation, lateral rotation, horizontal abduction, horizontal adduction
Nerve Supply
Axillary Nerve
Palpation
Place palpating hand just proximal to the deltoid tuberosity. Model actively abduct s the arm. Anterior deltoid: Place hand on anterior shoulder. Have client actively horizontally flex the arm at the shoulder joint. Posterior deltoid: Place palpating hand just inferior to the spine of the scapula. Model actively horizontally extends the arm at the shoulder joint
Deltoid

14. Glenohumeral Flexion

15. Pectoralis Major Origin Insertion Action Nerve Supply Palpation
Clavicular head: Medial half of the anterior surface of clavicle. Sternal head: Anterior surface of the manubrium ad bod of sternum, anterior aspect of upper six costal cartilages and anterior past of the 6th rib and aponeurosis of external oblique .
Insertion
Lateral lip of intertubercular groove
Action
Adduction and medial rotation. Flexion to horizontal. Extension to neutral
Nerve Supply
Posterior primary rami of C1
Palpation
From seated model raises arm to 90 degrees of abduction at the shoulder joint. Place palpating hand on the belly of the muscle. Ask the client to actively horizontally flex the arm at the shoulder joint against resistance and feel for the contraction of the pectoralis major.
Pectoralis Major

16. Biceps Brachii Origin Insertion Action Nerve Supply Palpation
Long head: Supraglenoid tubercle of the scapula and glenoid labrum. Short head: coracoid process of the scapula
Insertion
Posterior part of the radial tuberosity and bicipital aponeurosis
Action
Shoulder flexion, stabilise humeral head into glenoid. Elbow flexion and supination
Nerve Supply
Musculocutaneous nerve
Palpation
Long head tendon: 0° adduction, 20° medial rotation. Palpate the tendon in triangle bounded by medial deltoid, inferior clavicle and lateral pectoralis major.

17. Coracobrachialis Origin Insertion Action Nerve Supply Palpation
Coracoid process of scapula
Insertion
Medial side of the shaft of the humerus
Action
Adduction and flexion
Nerve Supply
Musculocutaneous nerve
Palpation
Supine, 90° abduction and forearm supination. Therapist’s places fingers medial surface of the upper arm posterior to biceps brachii. Resist horizontal adduction to confirm palpation

18. Glenohumeral Extension

19. Latissimus Dorsi Origin Insertion Action Nerve Supply Palpation
Spinous processes of lower six thoracic and all lumbar and sacral vertebrae, supraspinous and interspinous ligaments, outer lip of iliac crest, outer surfaces of lower 3 or 4 ribs and inferior angle of the scapula
Insertion
Intertubercular sulcus of humerus
Action
Extends, abducts and medially rotates shoulder
Nerve Supply
Thoracodorsal nerve and the posterior cord of the brachial plexus
Palpation
Model seated with hands at their sides. Place palpating hand on posterior axillary fold and ask the model to push down on the table with both hands, attempting to elevate the pelvis and trunk off the table. Feel for the contraction of the latissimusdorsi
Latissimus Dorsi

20. Teres Major Origin Insertion Action Nerve Supply Palpation
Dorsal surface of the scapular and inferior angle
Insertion
Medial lip of intertubercular groove of humerus
Action
Adduction, medial rotation and extension
Nerve Supply
Lower subscapular nerve
Palpation
Prone with arm off side of table. Grasp lat dorsi between your fingers and thumb. Move medially to scapula lateral border. Medial muscle fibres to lat dorsi is teres major

21. Triceps (Long Head) Origin Insertion Action Nerve Supply Palpation
Infraglenoid tubercle of the scapula and the adjacent glenoid labrum
Insertion
Proximal surface of the olecranon of the ulna
Action
Shoulder adduction and extension. Elbow extension
Nerve Supply
Radial Nerve
Palpation
Have model extend the elbow. Palpate in the proximal medial 2/3 of the arm

22. Glenohumeral Lateral Rotation

23. Teres Minor Origin Insertion Action Nerve Supply Palpation
Upper two thirds of lateral border of scapula
Insertion
Inferior facet of greater tubercle
Action
Lateral rotation
Nerve Supply
Axillary nerve
Palpation
Tendon: Patient prone on elbows, 90° shoulder flexion, 10° shoulder adduction and 20° lateral rotation. Palpate deep to deltoid and inferior to infraspinatus

24. Infraspinatus Origin Insertion Action Nerve Supply Palpation
Medial two thirds of infraspinous fossa of scapula
Insertion
Middle facet of greater tubercle of humerus
Action
Lateral rotation
Nerve Supply
Suprascapular nerve
Palpation
Tendon: Patient prone on elbows, 90° shoulder flexion, 10° shoulder adduction and 20° lateral rotation. Palpate deep to deltoid

25. Glenohumeral Medial Rotation

26. Subscapularis Origin Insertion Action Nerve Supply Palpation
Medial two third of subscapular fossa
Insertion
Lesser tubercle of humerus
Action
Medial rotation and adduction
Nerve Supply
Upper and Lower subscapular nerve
Palpation
Supine, passively flexion, abduction and protraction of the arm. Palpate the lateral border of the scapular anteriorly Tendon: 0° adduction, medial/lateral rotation. Palpate deep into the deltopectoral triangle

27. Muscular Anatomy Summary
Shoulder Girdle

28. Retraction Protraction Rhomboid Major Rhomboid Minor Trapezius
Serratus Anterior
Pectoralis Minor

29. Trapezius (Upper Fibres)
Elevation
Trapezius (Upper Fibres)
Levator Scapulae
Upward Rotation
Trapezius
Serratus Anterior

30. Downward Rotation Rhomboid Major Rhomboid Minor Pectoralis Minor
Levator Scapulae

31. Trapezius (Lower Fibres)
Posterior Tilt
Trapezius (Lower Fibres)
Anterior Tilt
Pectoralis Minor

32. Muscular Anatomy Summary
Glenohumeral

34. Extension Adduction Latissimus Dorsi Teres Major Deltoid
Triceps (Long Head
Adduction
Coracobrachialis
Pectoralis Major

35. Medial Rotation Lateral Rotation Subscapularis Teres Major
Latissimus Dorsi
Pectoralis Major
Deltoid
Lateral Rotation
Infraspinatus